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Ear, Nose, and Throat Disorders

Nasal endoscopy clear but sinusitis symptoms

11/25/2008

Question:

Hi. Thanks for reviewing my question.

For the past 3 months I`ve had painful tender cheeks (skin feels warm) .. pressing on them right under the cheekbones and towards the bridge of the nose. The sensation appears to be above the top teeth.

Recently, my doctor referred me to an allergy doctor to see if perhaps I had allergies .. testing was negative for all items. The allergy doctor suggested it may be chronic sinuses specifically the maxillary sinuses since that is the location where my symptoms are .. he suggested using the Neilmed sinus rinse bottle and provided a cortisteroid spray. My doctor put me on 3 week cefuroxime antibiotic.

The first 2 weeks the only drainage experienced was clear sometimes thick and especially bending over it would drip and at times a stream of would come out.

Suddenly the drainage went from thick/clear to bright yellow with blood streaks. This drainage has happened multiple times a day for 11 days. 3 days ago the yellow stopped and now it is only the clear/thick discharge again. The tight painful tender cheeks is still present.

Today I saw the ENT that I had seen when the symptoms started and he did a nasal endoscopy again. He said the nasal structures looks good and the ducts are open and there is no signs of inflammation or pus.

I mentioned the 11 days of bright neon yellow discharge mixed with streaks of blood but he says he sees no evidence in the nose of anything going on.

I`m confused. Could you be experiencing a deep rooted infection in the maxillary sinus and a nasal examination would be normal and unrevealing ?? In other words the issue is either the ostium duct or infection in the sinus but the nasal structure shows no evidence since the problem is really in the sinus?

Thank you for your time.

Answer:

It is true that it is possible to have a negative intra-nasal exam in your situation. A CT scan of the sinuses would obtain more information in your situation. This would allow a view of the sinuses which cannot be seen on routine endoscopy in a nose that has not had sinus surgery.

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Response by:

Lee   Zimmer, MD Lee Zimmer, MD
Assistant Professor or Otolaryngology, Director of Endoscopic Cranial Base Center
College of Medicine
University of Cincinnati